On the relationship between local hemodynamics and wall changes in cerebral aneurysms- A rare case with complete vascular tissue and lumen geometry*

Intracranial aneurysms represent a significant medical challenge due to their potential for sudden rupture and consequent severe physical disabilities. Deciding on treatment – high-risk surgery or leaving them untreated - is a complex dilemma that stems from the absence of reliable rupture risk assessments. Accurate risk assessment requires conjoined studies of mechanics and wall biology to unveil precise failure mechanisms. However, the challenge lies in the infeasibility of capturing tissues' microstructures in vivo. Here we have a rare case with premortem clinical CTA images and postmortem dissected tissue from an entire aneurysm and neighboring vasculature. We implement a framework for generating a high-fidelity computational model and perform in silico simulation to identify how intramural wall structure is correlated with heterogeneous aneurysm flow and wall stress. In-vivo CT images were used to create the vasculature model for blood flow simulations, and post-mortem micro-CT and multiphoton images of the vascular wall were employed to create the 3D wall model, its lipid pool, collagen, and elastin matrices. The presented framework enables efficient implementation of these scarce invaluable data sources to understand how flow patterns impact wall integrity and strength.